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A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

Published online by Cambridge University Press:  16 October 2019

Valentina Cardi
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Gaia Albano
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
Suman Ambwani
Affiliation:
Department of Psychology, Dickinson College, Carlisle, PA, USA
Li Cao
Affiliation:
Sanford Center for Biobehavioral Research, Fargo, ND, USA Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
Ross D. Crosby
Affiliation:
Sanford Center for Biobehavioral Research, Fargo, ND, USA Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
Pamela Macdonald
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Ulrike Schmidt
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Janet Treasure
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Corresponding
E-mail address:

Abstract

Background

Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.

Methods

Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.

Results

Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.

Conclusions

Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2019

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References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Arlington, VA: American Psychiatric Association.Google Scholar
Brauhardt, A, de Zwaan, M and Hilbert, A (2014) The therapeutic process in psychological treatments for eating disorders: a systematic review. International Journal of Eating Disorders 47, 565584.CrossRefGoogle ScholarPubMed
Brewin, N, Wales, J, Cashmore, R, Plateau, CR, Dean, B, Cousins, T and Arcelus, J (2016) Evaluation of a Motivation and Psycho-Educational Guided Self-Help Intervention for People with Eating Disorders (MOPED). European Eating Disorders Review 24, 241246.CrossRefGoogle Scholar
Byrne, S, Wade, T, Hay, P, Touyz, S, Fairburn, CG, Treasure, J, Schmidt, U, McIntosh, V, Allen, K, Fursland, A and Crosby, RD (2017) A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychological Medicine 47, 28232833.CrossRefGoogle ScholarPubMed
Cardi, V, Ambwani, S, Crosby, R, Macdonald, P, Todd, G, Park, J, Moss, S, Schmidt, U and Treasure, J (2015) Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial. Trials 16, 165.CrossRefGoogle ScholarPubMed
Cardi, V, Ambwani, S, Robinson, E, Albano, G, Macdonald, P, Aya, V, Rowlands, K, Todd, G, Schmidt, U, Landau, S, Arcelus, J, Beecham, J and Treasure, J (2017) Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise (TRIANGLE): study protocol for a randomised controlled trial. European Eating Disorders Review 25, 512523.CrossRefGoogle ScholarPubMed
Clausen, L, Lübeck, M and Jones, A (2013) Motivation to change in the eating disorders: a systematic review. International Journal of Eating Disorders 46, 755763.CrossRefGoogle ScholarPubMed
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd Edn. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.Google Scholar
Cruwys, T, Alexander Haslam, S, Dingle, GA, Jetten, J, Hornsey, MJ, Desdemona Chong, EM and Oei, TP (2014) Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings. Journal of Affective Disorders 159, 139146.CrossRefGoogle ScholarPubMed
Dawson, L, Mullan, B, Touyz, S and Rhodes, P (2018) Are recovery stories helpful for women with eating disorders? A pilot study and commentary on future research. Journal of Eating Disorders 6, 110.CrossRefGoogle ScholarPubMed
Dejong, H, Broadbent, H and Schmidt, U (2012) A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders 45, 635647.CrossRefGoogle ScholarPubMed
Denison-Day, J, Appleton, KM, Newell, C and Muir, S (2018) Improving motivation to change amongst individuals with eating disorders: a systematic review. International Journal of Eating Disorders 51, 10331050.CrossRefGoogle ScholarPubMed
Denison-Day, J, Muir, S, Newell, C and Appleton, KM (2019) A web-based intervention (MotivATE) to increase attendance at an eating disorder service assessment appointment: Zelen randomized controlled trial. Journal of Medical Internet Research 21, e11874.CrossRefGoogle ScholarPubMed
Dingle, GA, Stark, C, Cruwys, T and Best, D (2015) Breaking good: breaking ties with social groups may be good for recovery from substance misuse. British Journal of Social Psychology 54, 236254.CrossRefGoogle ScholarPubMed
Eddy, KT, Tabri, N, Thomas, JJ, Murray, HB, Keshaviah, A, Hastings, E, Edkins, K, Krishna, M, Herzog, DB, Keel, PK and Franko, DL (2017) Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. The Journal of Clinical Psychiatry 78, 184189.CrossRefGoogle ScholarPubMed
Fairburn, CG and Beglin, SJ (1994) Assessment of eating disorder psychopathology: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363370.Google ScholarPubMed
Fichter, MM, Quadflieg, N, Crosby, RD and Koch, S (2017) Long-term outcome of anorexia nervosa: results from a large clinical longitudinal study. International Journal of Eating Disorders 50, 10181030.CrossRefGoogle ScholarPubMed
Frings, D and Albery, IP (2015) The Social Identity Model of Cessation Maintenance: formulation and initial evidence. Addictive Behaviors 44, 3542.CrossRefGoogle ScholarPubMed
Hibbs, R, Magill, N, Goddard, E, Rhind, C, Raenker, S, Macdonald, P, Todd, G, Arcelus, J, Morgan, J, Beecham, J, Schmidt, U, Landau, S and Treasure, J (2015) Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial. BJPsych Open 20, 5566.Google Scholar
Kraemer, HC and Thiemann, S (1987) How Many Subjects? Statistical Power Analysis in Research. Thousand Oaks, CA, USA: Sage Publications, Inc.Google Scholar
Leamy, M, Bird, V, Le Boutillier, C, Williams, J and Slade, M (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry 199, 445452.CrossRefGoogle ScholarPubMed
Linardon, J, Brennan, L and de la Piedad Garcia, X (2016) Rapid response to eating disorder treatment: a systematic review and meta-analysis. International Journal of Eating Disorders 49, 905919.CrossRefGoogle ScholarPubMed
Lock, J, Kraemer, HC, Jo, B and Couturier, J (2018) When meta-analyses get it wrong: response to ‘treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials’. Psychological Medicine 49, 697698.CrossRefGoogle ScholarPubMed
Lovibond, S and Lovibond, P (1995) Manual for the Depression Anxiety and Stress Scales, 2nd Edn. Sydney: Psychology Foundation.Google Scholar
Mundt, JC, Marks, IM, Shear, MK and Greist, JM (2002) The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461464.CrossRefGoogle ScholarPubMed
Murray, SB, Loeb, KL and Le Grange, D (2018) Treatment outcome reporting in anorexia nervosa: time for a paradigm shift? Journal of Eating Disorders 6, 10.CrossRefGoogle ScholarPubMed
Murray, SB, Quintana, DS, Loeb, KL, Griffiths, S and Le Grange, D (2019) Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine 49, 535544.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2017) Eating disorders: recognition and treatment [online]. NICE Guideline [NG69]. [Viewed 4 September 2019]. Available at https://www.nice.org.uk/guidance/ng69.Google Scholar
Nazar, BP, Gregor, LK, Albano, G, Marchica, A, LoCoco, G, Cardi, V and Treasure, J (2017) Early response to treatment in eating disorders: a systematic review and a diagnostic test accuracy meta-analysis. European Eating Disorders Review 25, 6779.CrossRefGoogle Scholar
Resmark, G, Kennedy, B, Mayer, M, Giel, K, Junne, F, Teufel, M, de Zwaan, M and Zipfel, S (2018) Manualised cognitive behaviour therapy for anorexia nervosa: use of treatment modules in the ANTOP study. Journal of Clinical Medicine 7, E398.CrossRefGoogle Scholar
Schafer, JL (1997) Analysis of Incomplete Multivariate Data. New York, NY: Chapman and Hall.CrossRefGoogle Scholar
Schlegl, S, Bürger, C, Schmidt, L, Herbst, N and Voderholzer, U (2015) The potential of technology-based psychological interventions for anorexia and bulimia nervosa: a systematic review and recommendations for future research. Journal of Medical Internet Research 17, e85.CrossRefGoogle ScholarPubMed
Schmidt, U and Treasure, J (2006) Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45(Pt. 3), 343366.CrossRefGoogle ScholarPubMed
Schmidt, U, Ryan, EG, Bartholdy, S, Renwick, B, Keyes, A, O'Hara, C, McClelland, J, Lose, A, Kenyon, M, Dejong, H, Broadbent, H, Loomes, R, Serpell, L, Richards, L, Johnson-Sabine, E, Boughton, N, Whitehead, L, Bonin, E, Beecham, J, Landau, S and Treasure, J (2016) Two-year follow-up of the MOSAIC trial: a multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa. International Journal of Eating Disorders 49, 793800.CrossRefGoogle ScholarPubMed
Sly, R, Morgan, JF, Mountford, VA and Lacey, JH (2013) Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eating Behaviors 14, 119123.CrossRefGoogle ScholarPubMed
Smith-Merry, J, Freeman, R and Sturdy, S (2011) Implementing recovery: an analysis of the key technologies in Scotland. International Journal of Mental Health Systems 5, 11.CrossRefGoogle ScholarPubMed
Stockford, C, Stenfert Kroese, B, Beesley, A and Leung, N (2018) Women's recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research. Eating Disorders 27, 343368.CrossRefGoogle ScholarPubMed
Thaler, L, Israel, M, Antunes, JM, Sarin, S, Zuroff, DC and Steiger, H (2016) An examination of the role of autonomous versus controlled motivation in predicting inpatient treatment outcome for anorexia nervosa. International Journal of Eating Disorders 49, 626629.CrossRefGoogle ScholarPubMed
Thomas, JJ, Vartanian, LR and Brownell, KD (2009) The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychological Bulletin 135, 407433.CrossRefGoogle Scholar
Treasure, J and Schmidt, U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders 1, 13.CrossRefGoogle ScholarPubMed
Treasure, J, Stein, D and Maguire, S (2015) Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention in Psychiatry 9, 173184.CrossRefGoogle Scholar
Vall, E and Wade, TD (2015) Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders 48, 946971.CrossRefGoogle ScholarPubMed
Wade, TD, Johnson, C and Byrne, SM (2018) Randomized controlled psychotherapy trials in eating disorders: improving their conduct, interpretation and usefulness. International Journal of Eating Disorders 51, 629636.CrossRefGoogle ScholarPubMed
Wales, J, Brewin, N, Cashmore, R, Haycraft, E, Baggott, J, Cooper, A and Arcelus, J (2016) Predictors of positive treatment outcome in people with anorexia nervosa treated in a specialized inpatient unit: the role of early response to treatment. European Eating Disorders Review 24, 417424.CrossRefGoogle Scholar
Williams, GC, Rodin, GC, Ryan, RM, Grolnick, WS and Deci, EL (1998) Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology 17, 269276.CrossRefGoogle ScholarPubMed
Zipfel, S, Löwe, B, Reas, DL, Deter, HC and Herzog, W (2000) Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet 355, 721722.CrossRefGoogle ScholarPubMed
Zipfel, S, Wild, B, Groß, G, Friederich, HC, Teufel, M, Schellberg, D, Giel, KE, de Zwaan, M, Dinkel, A, Herpertz, S, Burgmer, M, Löwe, B, Tagay, S, von Wietersheim, J, Zeeck, A, Schade-Brittinger, C, Schauenburg, H and Herzog, W (2014) Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 383, 127137.CrossRefGoogle ScholarPubMed
Zuroff, DC, Koestner, R, Moskowitz, DS, McBride, C, Marshall, M and Bagby, MR (2007) Autonomous motivation for therapy: a new common factor in brief treatments for depression. Psychotherapy Research 17, 137147.CrossRefGoogle Scholar
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